Health insurance claims at volume, without the backlog
Credtics reads medical invoices, discharge summaries and prescriptions, checks each line against the member's benefits and your agreed provider rates, and flags duplicate or split billing.
How can insurers automate health insurance claims?
Automate the line-by-line checks. Credtics reads each medical invoice, discharge summary and prescription, confirms member and dependant eligibility, checks procedures against the benefit plan and compares billed tariffs with agreed provider rates. Duplicate or split billing is flagged, and adjusters review a summary in 2 minutes.
Sound familiar?
Hundreds of small claims every day
Health claims are high volume, and each one still needs checking.
Tariffs that drift above agreed rates
Small overcharges per line add up across thousands of invoices.
Duplicate and split billing
The same visit billed twice, or one treatment split across invoices.
What changes for health claims
Eligibility checked first
Member and dependant status confirmed before anything else.
Benefits and limits applied
Each procedure checked against the member's benefit plan.
Provider tariffs verified
Billed amounts compared with your agreed provider rates.
Duplicate billing caught
Repeat and split charges across visits are flagged.
Health claim documents Credtics reads
- Pre-authorisation request
- Medical invoice and itemised bill
- Discharge summary
- Prescriptions and lab reports
- Member card
Checks on every health claim
- Member and dependant eligibility
- Procedure covered under the benefit plan
- Billed tariffs against agreed provider rates
- Duplicate or split billing across visits
From inbox to decision-ready in 2 minutes
Credtics does the reading, sorting and checking. Your adjusters keep the judgement.
Claim files come in from email, WhatsApp, your portal or the scanner. Credtics sorts every page into the right document type.
Policy numbers, dates, amounts, names and line items are pulled out, each with a confidence score you can see.
Each claim is checked against the policy schedule, your underwriting rules and your approval limits. Anything that does not add up is flagged, with the reason.
Your adjuster gets a one-page summary, the flags that matter and the evidence behind each one. They make the call.
Most software asks your team to change. Credtics changes for your team.
Credtics adopts your claim forms, policy wording and approval matrix exactly as they are. Your team keeps the process it trusts and gets it done faster. That is why training takes days, not months.
Talk to us about your claims| Aspect | Typical claims software | CredticsBuilt around your team |
|---|---|---|
| Who adapts | Your staff learn new screens and rules | Credtics adopts your existing forms, policies and approval matrix |
| Learning curve | Long training before anyone sees value | Short, because the output looks like the work they already do |
| Your process | Rebuilt around the vendor | Kept as it is, then made faster |
| Final decision | Often buried inside the tool | Always with your adjuster, with the evidence on screen |
| Talk through your claimsBook a call |
Common questions
Can Credtics check claims against agreed provider rates?
Which health claim documents does Credtics read?
Does Credtics decide whether a claim is paid?
Give your adjusters their day back. Starting this quarter.
In 20 minutes we'll learn how claims move through your team today, where the delays and leakage are, and whether Credtics can help. If it's a fit, we'll agree a next step together.
- A conversation about your claims process, not a sales pitch
- An honest view of where Credtics can help, and where it can't
- A clear next step if it's a fit: a tailored demo or a pilot
Pick a time for a 20-minute call
A discovery call on Google Meet. Times show in your time zone.
Calendar not loading? Open the booking page. Rather email? sales@credtics.com, we reply within one working day.